Discharge after Regional Anesthesia

Patients recovering from regional anesthesia must meet the same discharge criteria as patients recovering from general anesthesia. However, these outpatients must also fulfill additional criteria to ensure safe ambulation after central neuraxis blockade. With spinal or epidural anesthesia, it is generally accepted that motor and sensory function returns before sympathetic nerve function.^[377] Residual blockade of the sympathetic nerve supply to the bladder and urethra may cause urinary retention. Because it is advisable after spinal and epidural anesthesia for outpatients to be able to void, long-acting local anesthetics (e.g., bupivacaine, tetracaine) should be avoided in the ambulatory setting.^[370] The use of shorter-acting local anesthetics (e.g., lidocaine, procaine) with the addition of fentanyl can provide adequate spinal anesthesia without prolonging recovery. ^{[371] [372]} Before ambulation, these patients should have normal perianal (S4-5) sensation, the ability to plantar-flex the foot, and proprioception of the big toe.^[377] Thus, discharge criteria after spinal and epidural anesthesia should include the return of normal sensation, muscle strength, and proprioception, as well as the return of sympathetic nervous function.